I am a Senior Political Contributor at Forbes and the official 'token lefty,' as the title of the page suggests. However, writing from the 'left of center' should not be confused with writing for the left as I often annoy progressives just as much as I upset conservative thinkers. In addition to the pages of Forbes.com, you can find me every Saturday morning on your TV arguing with my more conservative colleagues on "Forbes on Fox" on the Fox News Network and at various other times during the week serving as a liberal talking head on other Fox News and Fox Business Network shows. I also serve as a Democratic strategist with Mercury Public Affairs.

6/24/2012 @ 5:34PM8,464 views

An Easy To Follow Primer For This Week's SCOTUS Healthcare Ruling

With the Supreme Court expected to hand down it’s decision on Obamacare as early as Monday morning, I thought it might be useful to provide a quick, easy to follow review of what the court will be deciding—and what it all might mean.

Is the matter ripe for review?

Believe it or not, one possible outcome could be a decision that any ruling is premature. While few expect this to be the result, it remains a possibility due to the fact that many of the provisions of the ACA being challenged —particularly the mandate provisions, subsidies and Medicaid changes—have not yet come into being and will not have an impact until 2014. As such, nobody can actually claim to have been ‘injured’ or affected by these parts of the new law at this time. In lawyer terms, this means that a matter is not ‘ripe’ for adjudication under the Federal Rules of Civil Procedure.

Should the Court determine that the current challenge has been presented before a decision would have any actual effect on a litigant, it could reject the entire case with the proviso that the matter can be brought in the future after there is an actual impact on someone.

An unlikely result but a possibility just the same.

Does the expansion of Medicaid to cover all Americans who earn at 133 percent above the Federal Poverty Line place an undue burden on the states, thus rendering the expansion unconstitutional?

While this issue has not gotten the press that has followed the mandate provisions of the health care legislation, how this issue is decided will have a major impact on the future of health care reform in America.

The ACA greatly expands the number of people who will be permitted to qualify for Medicaid, therefore putting a major dent in the number of uninsured Americans. The law does this by requiring, beginning January 1, 2014, that states open their Medicaid programs to include anyone under the age of 65 who earns 133 percent above the Federal Poverty Line— or less. While the federal government will pick up 100 percent of the additional costs of the program for three years, after that the states will be required to pay their share under the current Medicaid program sharing arrangement, meaning the states will pay about one-half of the bill.

In most states today, Medicaid eligibility is restricted to low income adults who are either over 65 (nursing home coverage), pregnant, a single parent living with a child or someone who meets certain disability standards. As a result, low income adults are generally not qualified for Medicaid, regardless of how poor they may be, unless they fit one of these categories for coverage.

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Another article where Rick Unger isn’t an aged cheerleader for Obamacare. Bravo! It looks like you are coming around, since you also sense PPACA will be thrown out, hopefully this week. Like Obama with 2 gay lovers at a vegas bridal drive through, Rick Unger can also “evolve.”

The 80/20 health insurance pool is a failed model because 1/3 of Americans are Obese! States are hemorrhaging their budgets to pay for healthcare Rick, before Obamacare sets them up for certain BK in 5 years.

Claim jumping is a huge problem in MASS costing millions. The $500 IRS lien on my credit is nothing compared to $9,000 it will probably cost each person by the time Obamacare fully destroys us in 2014. http://www.slideshare.net/CraigJCasey/claim-jumping-user-obamacare-to-get-more-cash/

An ‘aged’ cheerleader? Wow..really know how to hurt a guy. Your comment reveals just how far off the line you are. How do you accuse me of being a cheerleader for Obamacare and then point out that this is ‘another article’ where I am not doing the same? I write what I see however it becomes increasingly clear that it is you who have an agenda to pursue. By the way, I’m sure the private insurance companies will be interested to know that you disapprove of the 80-20 pool model. No doubt, once they hear that NoObamacare disapproves, they will be quick to change their business models!

Rick, several comments. First let me say I enjoy your columns. I never cease to learn something I had not considered, prior to reading your column. I try to read and understand all points of view prior to taking a side on any issue. That being said…. I reside in Massachusetts and am fortunate enough to have good healthcare. As you know it is mandated here and has worked quite well for several years. I think, at least in my mind, it is proof positive that mandated insurance on the Federal level can work and would probably work even better with a larger risk pool and 3% overhead like Medicare. One last point. I was recently hospitalized for the first time in 25 years over the Memorial Day weekend. I was shocked to see that it cost $13000.00 for a 4 day stay in the hospital, not counting doctors and labs and that was what the insurance company actually paid….not what was billed. I said to my wife….what would we do if we didn’t have insurance and had a serious illness. There is simply no way we could afford to go to the hospital without being financially ruined in the process. Without insurance, we would probably loose everything we worked for our entire lives from just one hospital visit. There is nothing like a first hand experience, to bring things into sharper focus. Our healthcare system is broken and single payer seems the best solution to me. Let’s hope Scotus agrees.

BobbyD – I agree with everything you say. Unfortunately, the viability of the mandate will not be decided based on its opportunity to resolve some big problems, it will decided on the question of Constitutionality. Ultimately, it may be left to the different states to put this together as you have done in Mass.

Rick….my bad. I do realize Scotus is not ruling on single payer. What I meant to say, was I believe single payer is the best overall solution, but I hope for now that Scotus at least upholds the mandate.

The American Action Forum and Center Forward recently released a poll that was conducted among Supreme Court clerks and attorneys. The poll showed that 57 percent of these ‘expert opinions’ expect the mandate to be struck down after justices’ questioning during oral arguments were unexpectedly hostile towards the law. Furthermore, 21 percent of the court clerks and attorneys polled said that they expect the court to rule the mandate to be completely severable, 48 percent said partially severable and 31 percent said non-severable. See http://bit.ly/OgvNZ2 for more information on the SCOTUS insiders poll. But as Rick said, “stay tuned” for Thursday’s decision.

I’ve spent most of my adult life living in South Korea and Hawaii, where I’ve had quality health care bolstered by universal health coverage. If the ACA is struck down, I may be stuck living in one of these two places until something is put in place in its stead. What’s the average time period between health reform attempts? Fifteen years? Sheesh.

Oh, if only Obama had reminded Republicans that the mandate was their idea in the first place, then maybe they wouldn’t have tried to strike this down. It’s funny how something that is sound actuary sense and good health economics is suddenly terrible just because Obama has championed it.

Anyway, maybe the preexisting conditions thing can remain without bankrupting the health insurance companies if they do it dental insurance style: you must enroll a month ahead of time and major work is not covered until six or twelve months later.